SHOULD THE PRACTICE OF HYPNOTHERAPY BE RESTRICTED TO DOCTORS?

Dr. Bryan Knight

"Should the practice of hypnotherapy be restricted to doctors?" Definitely not. Physicians cannot even agree among themselves about hypnotherapy. There has been an ongoing feud within medical circles since the beginnings with [Dr] Mesmer.

In the early years of the last century, surgeons were jeered at, even struck off their registers, for daring to reveal they had operated hundreds of times on patients with only hypnosis as an anesthetic.

Hypnosis in psychotherapy fared no better. When Dr Ambroise Liebeault began to practice hypnotherapy in 1860 he was ridiculed by his colleagues - despite the cures his patient enjoyed.

Today hypnosis is widely used by all kinds of medical personnel. In the 1950s both the British and the American Medical Associations endorsed hypnotherapy. However, a widespread belief among many physicians, dentists and PhD psychologists, is that the use of hypnosis should be restricted to themselves.

They accuse outsiders of not having adequate understanding, training or ethical standards to responsibly employ hypnosis, especially in psychotherapy. Typical of this view is the following accusation: "Stage hypnotists and other lay people, have trifled with hypnosis for a long time, mainly for sensational display. Many of them fancy themselves to be hypnotherapists and advertise themselves as such. Physicians and psychologists across the country have warned that the irresponsible practices of these lay people endanger the public interest, and attempts have been made to outlaw them" (Brown & Fromm, 1986, p.147). Brown and Fromm are right to be concerned about irresponsible practices but wrong to imply that only physicians and psychologists behave in the public interest.

Integrity is not something that is conferred along with a medical or psychological degree. If it were, 7% of psychiatrists and 12% of psychologists would not have had sex with their patients nor abused them in other ways such as enmeshing them in cults. As for abuse specifically involving hypnosis perhaps the most startling is murder. By a doctor. It is ironic that the case is cited by psychologists who want to restrict the use of hypnosis to professionals: "Some years ago, a physician/hypnotherapist who was having an extra-marital affair with a woman whom he wanted to marry hypnotized his wife and suggested to her that she was developing a headache. When the headache would become very severe, he told her, she would swallow all the pills in the bottle he had put in her lap. They would make her fall asleep, so she would not feel the pain any longer. After a while she reached for the pills and took them all. It was a lethal dose." (Brown and Fromm, 1986, p.146).

Another example of physician misuse of hypnosis is cited by a lawyer/psychologist who first says, "While the evidence appears overwhelming that hypnosis per se is a safe procedure that carries little risk to a subject, no such claim is made here with regard to the effect of ill-advised suggestions that have been made to subjects. Usually such suggestions are made by either lay hypnotherapists or persons with no psychological training, practicing outside the limits of their professional competence" (Udolf, 1981, p.276). Udolf then condemns two such "foolish" and "idiotic" suggestions by lay hypnotists. However, he does not condemn an equally stupid suggestion made by a doctor: "...an obstetrician, angered at a patient for not complying with his suggestions for weight reduction, [told] her that if she did not stick to her diet should kill her pet dog. While this suggestion may have been given by the physician with the intent of 'motivating' the patient, it probably resulted from his own unrecognized countertransferences feelings in response to this ego-bruising therapeutic failure. In any event, it was followed by the patient's actually killing the dog and her subsequent hospitalization with a diagnosis of paranoid schizophrenia." Even if the number of professional abusers is very small, it is still absurd for physicians and psychologists to imply that their training or ethics makes most of them immune to temptations of the flesh, incompetence, and self-delusion.

Doctors and psychologists are as frail as the rest of us. The supposed higher ethics of the professionals is unmasked by their willingness to lie. Many psychologists who shy away from the term 'hypnosis' nevertheless employ techniques (such as progressive relaxation coupled with visualization) that are virtually identical to hypnosis.

Such professionals apparently have no ethical qualms about misrepresenting what they do: "A certain number of subjects will be found who could benefit from hypnotic treatment but who fear being put into a trance and resist all attempts at reassurance. Such a subject can be hypnotized without ever using the words 'hypnosis' or 'sleep' [sic] by simply referring to what you are trying to attain as a 'deep state of relaxation"'. (Udolf, 1981, p.63). Other restrictors are proud to openly admit, "We even lie to patients, and we believe that is OK too as long as it is done for the purpose of helping them" (Citrenbaum, et al, 1985, p.14). Given the controversial nature of psychotherapeutic practice and the contradictions of its various theories, how can this minority of practitioners have the gall to insist that they are the only ones who know how to use hypnosis? Especially when some research suggests that two out of three trainee psychologists will be taught by a therapist who is himself either ineffective or harmful? (Cole, 1982).

Condescension is rife among restrictors. For example, they assert that only a doctor or a psychologist would realize the futility of using hypnosis to help an intoxicated person give up drinking (Getzlaf and Cross, 1988).

The spreading of fear of hypnosis by some medical people is a gross disservice to the public. How many thousands of persons have consequently steered away from the opportunity to harness this natural tool for relaxation, self-control, problem-solving and creative development? The restrictors claim that hypnosis can be dangerous -- but not if it's in their hands. This preposterous notion is belied by their own guidelines on how to reduce risks. Because it is not hypnosis itself but the unique interaction of the subject, hypnotist and environment which yields the occasional unwanted effect, the guidelines are quite properly concerned with these factors.

The most important of which is the character of the hypnotist. "Significant hypnotist risk factors are personal and professional.

Personal risk factors are:

" personality dynamics,

" verbal and non-verbal behaviours and

" style and sexual factors.

Professional risk factors are errors or deficiencies in:

" history taking,

" screening,

" informed consent,

" observation,

" diagnosis,

[and] unclear, ambiguous or confusing:

" suggestion,

" time and timing,

" word and imagery choice,

" interventions or lack of them,

" debriefing,

" de-hypnosis and follow-up." (MacHovec, 1988, p.63).

[emphases added].

There is nothing intrinsic to being a doctor or a psychologist that automatically eliminates the hypnotist risks listed by MacHovec. On the contrary, the would-be restrictors themselves say that being a medically trained person may in itself pose a risk! The hypnotized client can be harmed by the professional's habitual, non-hypnotic, ways of making suggestions or asking questions (Brown and Fromm, 1988).

All the professional factors can be learned and indeed, are often taught by the 'lay' hypnotists to medical and psychological practitioners. The battle for restriction of who can use hypnosis is really about power. Physicians want as much as they can grab. To add hypnosis to their monopoly has nothing to do with protecting the public, but everything to do with aggrandizing physicians. Psychologists, eager to garner a little prestige by cloaking themselves in medical rhetoric, are being used by doctors. Doctors know disease, not health. Yet they attempt to medicalise almost everything (e.g. childbirth). Unlike psychologists they cannot make even a pretense to expertise with the problems in living (shyness, low self-esteem, phobias, bad habits, sexual and other relationship difficulties, etc.) because these are rarely medically based.

But the restrictors are correct in suggesting

"Ideally, associations of hypnotists would protect the public from

inappropriate use of hypnosis and from claims that it will cure the

incurable" (Getzlaf and Cross, 1988, p.265).

"Lay" hypnotists are well advised to require clients to have a thorough

medical check-up. This protects both hypnotist and client.

If, for example, your doctor tells you that your headaches are caused by a

tumour, the responsibility for choice of treatment -- hypnotherapy and/or

surgery -- rests where it should: on you as an informed client.

References:

Brown, Daniel P., Fromm, Erika (1986). Hypnotherapy and Hypnoanalysis. Hillsdale, N.J.: Lawrence Erlbaum Associates.

Cole, David R. (1982). Helping: Origins and Development of the Major Psychotherapies. Toronto: Butterworths.

Citrenbaum, Charles M., King, Mark E., Cohen, William I. (1985). Modern

Clinical Hypnosis for Habit Control. New York: Norton.

Getzlaf, Shelly B., and Cross, Herbert J. (1988). Hypnotists Associations: A

Consumer's Confusion, The International Journal of Clinical and Experimental Hypnosis, XXXVI, 262-274.

MacHovec, Frank (1988). Hypnosis Complications, Risk Factors, and Prevention, American Journal of Clinical Hypnosis, 31, 40-49.

Udolf, Roy (1981). Handbook of Hypnosis for Professionals. New York: Van Nostrand Reinhold.

Bryan M. Knight, MSW, PhD writes in his book Health and Happiness with Hypnosis: The spreading of fear of hypnosis by some medical people is a gross disservice to the public. How many thousands of persons have consequently steered away from the opportunity to harness this natural tool for relaxation, self-control problem-solving, better health, and creative development! How much has such ignorance unnecessarily added to the nation's medical bills!

The restrictors claim that hypnosis can be dangerous - but not if it's in their hands. This is an absurd notion. Hypnosis is not dangerous. Unethical, ignorant, greedy or emotionally unbalanced people are dangerous. And that can describe a doctor or a psychologist just as well as it might describe a 'lay" hypnotist. Good character or high morals have to do with the kind of person you are, not with the degrees you've accumulated. Apart from character defects, therapists' errors in the use of hypnosis arise from inadequate training about hypnosis; obviously such deficiency could apply to anyone. (P 23)

Bryan M. Knight, MSW, Ph.D. Dr Knight can be reached by e-mail at drknight@hypnosisdepot.com  by regular mail at 7306 Sherbrooke Street West, Montreal, QC, Canada, H4B 1R7, and by phone at (514) 827-4673.. URL: http://www.hypnosisdepot.com/